1.INTRODUCTION

Located in the Metropolitan Area of the Port, the Port of Leixões serves a hinterland of 14 million inhabitants and has been recognised as a port of the Main Trans-European Transport Network (TEN-T). It is the second largest national port in terms of quantity of tons moved and the largest port in the northwest peninsula.

It is a gateway port, strategic for the national economy due to the multimodal transport solutions it offers. It is an essential support to companies in the north of the country because it promotes an offer of key services that contribute to the distribution of finished products and the supply of raw materials and consumer goods. For these reasons, the Port of Leixões plays a decisive role in the competitiveness and internationalization of Portuguese companies.

It is located in an Urban Area that produces a commercial surplus of 5 billion euros in goods transaction and that counts with the presence of the 16 Portuguese Municipalities with a higher export capability, from which containerized cargo leaves towards 182 Countries of the World, moving about 20 million tons of cargo annually.

Due to the fact that it is a versatile port, it offers differentiated operational infrastructures: solid and liquid bulk terminals, container terminals, multipurpose terminals, oil terminal, ro-ro terminal, commercial marina, fishing port, and 2 cruise terminals, through which about 100,000 passengers pass by annually.

These, associated with the ease of international movement of people and cargo and the speed with which this happens, determine a very significant human mobility, consisting not only of the daily players in the entire port operation and services but, above all, of the large number of crew and passengers of the most diverse nationalities who cross paths within the port and its surrounding areas. Thus, passenger ships pose an increased risk since they carry a high volume of people in confined spaces.

In terms of health hazard, the Port of Leixões thus presents a complex situation. As such, there is the need for an epidemiological surveillance system of the border to enable early and effective intervention, and an adequate alert and response capacity in an articulated and integrated manner, whether in case of a pandemic-like threat or situations of physical risk, which pose or may pose an increased risk to human beings.

The World Health Organization, the United Nations specialised body with primary responsibility for international health and public health issues, approved in May 2005 the 4th revision of the IHR - International Health Regulations, which identifies a set of procedures necessary for assessing public health in a cross-border context and reflects the concern of the international community about the possible health, social, economic and environmental consequences of the spread of epidemics.

The IHR, with the last revision in force since June 15, 2007, is a legal instrument binding 194 countries. Its purpose is to help the international community prevent and respond to public health risks that have the potential to cross borders and threaten the population worldwide.

The International Health Regulations to which Portugal is a State Party define in its Annex I-(B) the minimum requirements that the Designated Ports and Airports have to comply with, defining in paragraph 2(a) the obligation to ensure an adequate response to public health emergencies, establishing and maintaining a contingency plan for public health emergencies, including the designation of a coordinator and contact points, at the points of entry, in the public health services and other entities and services involved.

As such, the Port of Leixões, in compliance with its responsibilities as a Designated Port, prepared this Contingency Plan of the Leixões Port Authority (PCAPL), which describes the measures, in their most operational aspect to be implemented in case of the possibility of the occurrence of undesirable events that may endanger the life or health of the Port Community, in conjunction with:

the Port Health Authority and all local bodies involved in responding to public health emergencies, particularly those of the CCPOPL-Centre for the Coordination of Protection Operations of the Port of Leixões.

APDL's Occupational Health Services with responsibility for the defence and protection of its active collaborators, at the port and administrative,

the several port actors, namely its Distributors, whose plans are integrated and articulated with this Plan.

The Port of Leixões' Public Health Plan is part of the "PCAPL - Contingency Plan of the Port of Leixões, of the Health Authority of the Municipality of Matosinhos - International Health", which is responsible for testing and managing this plan in an integrated manner, counting with the help of the Coordinator of the Public Health Unit of Matosinhos, Mr. Jaime Batista, and his team, who are at the Port of Leixões' Health Unit 24 hours.

The Coordination of Port Intervention is ensured by the Health Authority-Mr. Jaime Batista, in articulation with the OPPL (Port Protection Officer) - Commander Rui Cunha

After three meetings within a week, the World Health Organization (WHO) declared that the coronavirus outbreak should be classified as a Public Health Emergency of International Concern (PHEIC) on 30-01-2020, and gave the 2019-nCoV the new designation of OVID-19 (Coronavirus Disease - 2019) on 11 February.

The present Contingency Plan was prepared within the scope of PHEIC following the recommendations of the World Health Organization (WHO) and the Standards and Guidelines of the Directorate General of Health (DGS), namely Guideline No. 005/2020 of 26/02/2929 - Procedures for Ports and Travellers by Sea, and Guideline No. 006/2020 of 26/02/202 - Procedures for the prevention, control and surveillance in companies, in conjunction with the Authority of the Public Health Unit of Matosinhos - Maritime Health and the Occupational Health services of APDL.

2.OBJECTIVES OF THE PLAN (PCAPPL)

The general objective of this Contingency Plan (PCAPL) is to minimise the effects of events that represent an increased risk to public health within the port operation, to ensure the articulation and harmonisation of procedures between the various Authorities of the Port of Leixões in order to provide an effective response to any situation considered as an emergency for public health by the Health Authority (HA), particularly in fighting the spread of COVID-19 that may occur on board of a ship that is moored or might eventually enter the Port of Leixões or its facilities.

It is an Operational Plan that defines a set of procedures and guidelines for operational action to be implemented under the coordination of the OPPL, as the entity responsible for coordinating port intervention, in permanent articulation and under the guidance of the Health Authority, responsible for coordinating health intervention in the port area.

3.PREDICTION AND WARNING SYSTEM / RISK SCENARIOS

The procedures associated with the various levels of alert are aimed at anticipating or becoming aware of events at an early stage in order to prevent, control and minimize their negative impacts, enabling, in case of knowing in advance the existence of a case on board, the decision on actions to be implemented before the ship berths.

The key elements for the risk analysis prior to the arrival of the ship are: the receipt of notifications from the ship, the possibility to communicate with other ports prior to the arrival of the ship, other authorities at local, regional and national level, and to assess the level of risk that may be posed by ports where the ship has been prior to its arrival.

Ships from affected areas may pose a health risk and information on affected areas as well as temporary or definitive recommendations issued by WHO may contribute to identifying events and deciding on the type of health measures to be implemented.

All routine procedures namely Free Practice, Health Clearance, requests for inspection and health visits are performed through the Electronic Platform (JUP/JUL).

The ship's captain notifies the ASP through the port information system (JUP) of the health risks as stated in the Maritime Declaration of Health (DMS) (IHR Article 37), explicitly responding to health issues on board, identified in the 8 mandatory fields in the DMS (image 1).

In order to ensure that all operational services involved in the planning and authorisation of the ship's entry are informed of the possibility of one of the 8 fields mentioned above being positive, which could therefore constitute a situation of increased health risk, an Automatic Notification feature for the entire Port Health Authority team, the Port Authority services, namely the OPPL, and the other authorities (SEF/GNR/CAPITANIA) (image 1) has been implemented.

Ships coming from affected areas may represent an added risk for the dissemination of the COVID-19. As such, prior analysis of the ports ships have been to prior to their arrival in Leixões and the journey times are essential data for the analysis on a case-by-case level, and for the possible need to define additional protective measures, both at the port facility, and for the services that contact directly with crews and passengers (Pilots / Boat Crews / Terminal Operators...).

Image 2 – APP for analysis of prior ports and journey times

In order to be able to carry out an assessment prior to the arrival of the ships and take any additional protective measures, or support the decision making together with the Port Health Authority and other Authorities and all those involved in port operations and services, an APP was developed to analyse all ships supposed to call at the port. It creates an alert for ships coming from ports at risk and it also identifies the time spent in those ports and their journey time from those ports to the Port of Leixões. (image 2)

If there is the possibility of having a few days in between the introduction of the Maritime Declaration of Health (DMS) in the port information system (JUP) and the arrival of the ship to port, the traffic control service -VTS - verifies the ship at least two hours before its arrival, making sure that there is no change to the health conditions on board, and that everything is in accordance with the prior notification on the DMS.

The Port Planning Service and the Port of Leixões Protection Officer must be immediately informed of any change, being responsible for informing the Port Health Authority by changing the traffic light for authorisation of entry to red.

4.RISK SCENARIOS / WARNING LEVELS

The risk scenarios and the subsequent levels of alert depend on situations that could change the increased risk to health for crew and/or passengers of ships arriving or moored at the Port of Leixões, as well as for any of the parties involved in the port operation, who are the first line of intervention and, therefore, have direct contact with the ship and / or the port community.

The need to activate the organisational structures for an adequate and timely response must be in line with the risk assessment carried out by the Health Authority. The levels of activation of structures and parties and the subsequent mobilisation of human and material resources are defined according to the level of the threat:

The activation phases of the Plan are defined according to the risk level:

At this stage, news of possible isolated cases by imported transmission have emerged in Portugal.

It corresponds to the occurrence of national or international Public Health events that may be of interest to partners.

These events are usually monitored and managed at a local level

Activity in the port area remains normal, with absence of alerts about occurrences or events that may represent increased risk for crew / passengers, port agents and / or population.

Phase 2 - The Concern Stage – Yellow Alert Level

It corresponds to the moment of exponential resurgence of infected people worldwide, a situation that threatens the normal functioning of organisations. There are public health events that require a coordinated response with the involvement of additional resources at a regional and/or national level.

There are one or more cases in crew members and/or passengers with low impact in the port area. The situation is under control with the adoption of active measures.

Phase 3 –Operational phase

It corresponds to the moment of exponential emergence of infected people in the area, and it is anticipated that, in addition to the actions listed in the previous phases, it may be necessary to mobilise extra resources at regional and national levels. The threat is real, and it corresponds to a Public Health Emergency of National Concern

In the port area, there are several cases amongst crew and passengers and/or within the port community and population. There is the need for suspension of mobility in the port area and/or prohibition of entry of ships, with the need to define minimum essential services

Communication of risk

Communication to partners and the population is the responsibility of the Health Authority and will be ensured in conjunction with the other Authorities.

5.OPERATIONAL RESPONSE AND COORDINATION STRUCTURE

With regards to human and organizational resources, the implementation of the actions included in the PCAPL requires an articulation of efforts of all services of APDL and an efficient articulation and communication with the Port Health Authority, the Different Entities of the Port and the Port Community in order to meet the necessary standards of efficiency:

All operational services of APDL and vessel services are active and on standby 24 x 365 days, through the contacts available in the contact list:

VTS- Vessel Traffic Service – Navigation control

Pilotage and Tug Service

Planning and coordination of navigation and services

Security and video surveillance centre

OPPL – The Port Protection Officer is contactable 24/7, either directly or through the services above, which are entirely of his responsibility.

The Maritime Health in Leixões operates 24 hours a day, 7 days a week, and it is formed by a team with specific, permanent training:

Coordinator - Mr Jaime Baptista

Doctor - Mr Nuno Rodrigues;

TSA - Fátima Sousa and Miguel Maia;

Nurses - Sérgio Sousa and Teresa Cardoso.

All routine procedures, namely: Free Practice, Health Clearance, requests for inspections and health visits will be done through the Electronic Platform (JUP/JUL).

In an emergency, even though the procedure is to record all information through the JUP/JUL, direct telephone contact with the authorities and other entities involved will be favoured.

This plan is in accordance with the Contingency Plan of the Port of Leixões of the Health Authority of Matosinhos (PCAPL). As such, communication between the entities involved uses the procedures laid out in it, which are very fast means of communication.

The Shipping Agent contacts the port's Health Authority (Maritime Health Service) and informs APDL- OPPL (Port Protection Officer) or the Planning Service or the VTS.

The OPPL or the VTS informs the Port Authority and SEF

Boarding and disembarkation of ships are immediately prohibited, except for the Health Authorities / INEM, being normal operation resumed with the explicit authorization of the Port Health Authority only

THE HEALTH AUTHORITY EVALUATES THE SITUATION AND, IF THE SUSPICION IS CONFIRMED:

Gives the first guidelines for the patient to be placed in isolation. The patient should be separated from the other crew members and passengers, and activities outside their cabin should be restricted. A sanitary facility should be designated for the exclusive use of the patient;

Provides the patient with a surgical mask. The mask should be put on by the patient himself and be well adjusted;

Immediately calls the Medical Helpline of the Directorate General of Health (DGS) (300 015 015) to validate the suspicion.

Image 4

IF THE CASE IS NOT VALIDATED by the Medical Helpline of the DGS,

The situation is closed for COVID-19 and the usual procedures set forth for the management of patients on-board that are suitable for the clinical situation should be activated.

IF THE CASE IS VALIDATED by the Medical Helpline of the DGS,

The indications for managing a Suspected Case of COVID-19 on board should be followed:

Only one designated crew member should assist the patient;

While on-board, the patient must be kept in isolation, wearing a surgical mask as long as their clinical condition allows and until the arrival of the team from the National Institute of Medical Emergency (INEM), called by the DGS;

If the ship is moored, the INEM team may enter the ship and ensure that the patient is disembarked to transport him from the port to the reference Hospital;

No person shall enter the cabin or isolation area where the patient was staying until the cleaning and disinfection procedures have been completed, or until the laboratory result has come back negative. This ban can only be lifted by the Health Authority;

Close contact information should be collected from the patient using the Passenger Location Card (PLC) (Annex I of OT No. 005/2020);

The following are considered close contacts on board:

People who have had direct contact with the patient (e.g. relatives, travelling companions (cabin) or people who provided assistance, or others defined by the Health Authority.

If the vessel contacts the VTS or is contacted by it to report the existence of a patient on board, the VTS informs the vessel to contact the MRCC, establishing, in the meantime, contact with this service.

It will immediately alert the Maritime Health and the Port Authority, informing the CCN - Ship Control Centre, which will then contact the OPPL.

No pilot shall be appointed to perform the manoeuvre without the explicit authorization of the Maritime Health, and without the knowledge of the OPPL.

The doctor on duty at CODU-Mar contacts the Medical Helpline for validation of the case. All the procedures previously described at the port are applied (a call to the INEM team to transport the patient, in articulation with the Port Health Authority)

The doctor on duty at CODU-Mar contacts the Medical Helpline for validation of the case.

If the case is validated, the MRCC liaises with the designated Maritime Health Authority (call of duty at national level) to assist in the decision making regarding the port of call (Leixões), in order to ensure the most effective way of the procedure for managing the patient and its transmission to the Captain.

Once the port of destination (Leixões) has been defined, the Maritime Health Authority on call informs the doctor of the DGS Medical Help Line, which activates the Regional Health Authority with jurisdiction in the geographical area of the port of destination.

The Regional Health Authority should get in touch with the Health Authority of the port of destination to obtain information regarding the terminal and berth of the ship. This precise information regarding the name of the ship and the berth should be communicated to LAM, which in turn will transmit the necessary information to the INEM team, which will ensure the disembarkation of the patient and their transport from the port to the reference Hospital.

Image 6

If the vessel wishes to enter the port, it must appoint a Shipping Agent who will request permission to enter the port to the various authorities in the port information system (JUP), and the Port Authority must issue a statement of arrival.

Entry at the port may only be scheduled after authorisation from the Maritime Health Department in conjunction with the OPPL. The most appropriate pier for disembarking the patient and facilitating the access of the health services on board must be designated.

The Maritime Declaration of Health (Annex 8 of the International Health Regulations) should be uploaded to the electronic platform.

The Free Circulation of the vessel with a Suspected Case of COVID-19 can only be granted after the Health Authority has assessed the situation.

6. SUSPECTED CASE IN PORT FACILITIES

Each port facility has its own plan in which the isolation rooms are identified. As such, in case of any suspicion, the Facility Plan will be activated by its OPIP-Port Facility Protection Officer or other person responsible for the Plan, informing the OPP immediately and following the communication flow together. (figure 7)

Any member of the port community who identifies a person falling under the definition of a suspected case of COVID-19 in port facilities should contact the port management.

In the event of a confirmed case, in addition to the procedures described above, the procedures for active surveillance of close contacts referred to in point 5.2 of the DGS guideline No 002/2020 of 25/01/2020, updated on 10/02, should also be activated.

After a trip with a confirmed case on board, the following considerations shall be taken into account:

After the patient has left the ship, cleaning and disinfection procedures must be guaranteed;

Cleaning must be performed by professionals with training in the use of Personal Protective Equipment (PPE) (gown, mask (preferably FFP2), cap, goggles with side protection and gloves for single use, according to Guideline No. 03/2020 of 30/01/2020

Compressed air equipment must not be used due to the risk of aerosol recirculation;

Cleaning and disinfection should be done more often than usual, especially on surfaces for public use and with which the patient has had contact, which are more likely to be contaminated. Special attention should be paid to the cabin where the patient has been (e.g. table / trays and other materials / equipment used by the patient);

Cleaning equipment for single use must be used. If the equipment is for multiple use, it should be cleaned and disinfected after use;

Cleaning must be done before the use of disinfectants.

The cleaning and disinfection of surfaces should be done with:

A degreasing detergent, followed by

An appropriate disinfectant, used in accordance with the manufacturer's recommendations;

The treatment of bed linen / towels and dishes used by the patient must follow the procedures set forth by the Guideline nº 03/2020 of 30/01/2020;

Biohazardous waste (including hand wipes and tissues) must be placed in a plastic bag which, after it is closed, must be stored in a hard container and sent for incineration, or other similarly efficient method

The above recommendations also apply to the isolation area and other potentially contaminated areas of port facilities;